Intrinzična inzulinska rezistencija u nedijabetičara i pojava hiperglikemije u teškoj akutnoj bolesti [ Intrinsic insulin resistance among nondiabetics and occurrence of hyperglycemia in critical illness]

Introduction: Insulin resistance is characterized by reduced response of target cells to exposed insulin concentration. It is part of type 2 diabetes, metabolic syndrome, obesity and underlying cause of cardiovascular and neurodegenerative diseases. Hyperglycemia commonly occures in the course of any critical illness. It appeares both among patient with or without apparent glucose metabolism disorder. We hypothesised that the cause of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder lies in intrinsically increased insulin resistance of those patients. Patients and methods: Patients admitted to the intensive care unit of the University Hospital Centre Zagreb due to critical illness were included in the research. Patients with no history of impaired glucose metabolism were divided into hyperglycemia group (glucose >7.7 mmol/l, measured on at least two occasions) and normoglycemia group. Glycated haemoglobin during hospital stay and oral glucose tolerance test within 6-8 weeks after discharge were all performed in order to disclose patients with unknown diabetes or pre-diabetes who were excluded from the research. On the ambulatory appointment 6-8 weeks after discharge insulin resistance is assessed by indirect methods. Insulin resistance was measured with simple indices: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Results: Research was concluded on 221 patients, 114 were in hyperglycemia group while 107 were part of normoglycemia group. There were no signifficant differences in age nor sex among groups. BMI, WHR and positive family history of DM type II showed higher values in hyperglycemia group. Patients in hyperglycemia group had signifficant higher values of insulin resistance measured with all simple insulin resistance indices compared with patients in normoglycemia group. Multivariate logistic regression analysis showed independent association of BMI, WHR, HOMA-IR and QUICKI with occurrence of hyperglycemia in acute illness. Conslusion: Occurrence of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder is associated with intrinsically increased insulin resistance

Intrinsic insulin resistance among nondiabetics and occurrence of hyperglycemia in critical illness

Uvod: Inzulinska rezistencija karakterizirana je smanjenim odgovorom ciljanih stanica na izloženu koncentraciju inzulina. Teško ju je odvojiti od šećerne bolesti tip II, metaboličkog sindroma i pretilosti, a nalazi se u podlozi nastanka kardiovaskularnih i neurodegenerativnih bolesti. Hiperglikemija u akutnoj bolesti čest je nalaz kod pacijenata hospitaliziranih u jedinicama intenzivnog liječenja. Javlja se kod pacijenata s prethodno poznatim poremećajem metabolizma glukoze (DM, IFG, IGT), kao prva manifestacija dotada nedijagnosticirane šećerne bolesti te kod pacijenta koji imaju uredan metabolizam glukoze prije i nakon hospitalizacije. Hipoteza istraživanja jest da je pojava hiperglikemije u teškoj akutnoj bolesti povezana s intrinzično povišenom inzulinskom rezistencijom kod pacijenata koji nemaju manifestan poremećaj metabolizma glukoze. Ispitanici i metode: U istraživanje su uključeni pacijenti primljeni u Zavod za intenzivnu medicinu Klinike za unutrašnje bolesti KBC Zagreb radi teške akutne bolesti. Pacijenti bez poznatog poremećaja metabolizma glukoze podijeljeni su u skupinu hiperglikemije (GUK >7.7 mmol/l u najmanje 2 mjerenja) i normoglikemije. Postojanje ranije neprepoznatog poremećaja metabolizma glukoze isključeno je određivanjem HbA1c za vrijeme hospitalizacije i OGTT učinjenim na ambulantoj kontroli 6-8 tjedana nakon hospitalizacije. Na ambulantnoj kontroli 6-8 tjedana nakon hospitalizacije pacijentima je uzet uzorak krvi natašte iz kojeg je indirektnim metodama određena inzulinska rezistencija. Inzulinska rezistencija određena je jednostavnim indeksima: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Rezultati: Istraživanje je završeno na 221 pacijentu. Hiperglikemičnu skupinu činilo je 114 pacijenata, dok se u normoglikemičnoj skupini nalazilo 107 pacijenata. Analizom podataka među skupinama nije zamjećena statistički značajna razlika u dobi niti spolu pacijenata. Vrijednost indeksa tjelesne mase, omjera struka i bokova te pozitivna obiteljska anamneza šećerne bolesti bila je statistički značajno viša u hiperglikemičnoj skupini. Skupina bolesnika koja je razvila hiperglikemiju za vrijeme akutne bolesti ima statistički značajno višu vrijednost inzulinske rezistencije nakon hospitalizacije prema svim jednostavnim indeksima u usporedbi sa skupinom koja je ostala normoglikemična za vrijeme akutne bolesti. Multivarijatna analiza logističkom regresijom pokazala je neovisnu povezanost indeksa 76 tjelesne mase, vrijednost omjera struka i bokova, HOMA-IR i QUICKI s pojavom hiperglikemije u akutnoj bolesti. Zaključak: Pojava hiperglikemije u teškoj akutnoj bolesti povezana je s intrinzično povišenom inzulinskom rezistencijom kod pacijenata koji nemaju manifestan poremećaj metabolizma glukoze.Introduction: Insulin resistance is characterized by reduced response of target cells to exposed insulin concentration. It is part of type 2 diabetes, metabolic syndrome, obesity and underlying cause of cardiovascular and neurodegenerative diseases. Hyperglycemia commonly occures in the course of any critical illness. It appeares both among patient with or without apparent glucose metabolism disorder. We hypothesised that the cause of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder lies in intrinsically increased insulin resistance of those patients. Patients and methods: Patients admitted to the intensive care unit of the University Hospital Centre Zagreb due to critical illness were included in the research. Patients with no history of impaired glucose metabolism were divided into hyperglycemia group (glucose >7.7 mmol/l, measured on at least two occasions) and normoglycemia group. Glycated haemoglobin during hospital stay and oral glucose tolerance test within 6-8 weeks after discharge were all performed in order to disclose patients with unknown diabetes or pre-diabetes who were excluded from the research. On the ambulatory appointment 6-8 weeks after discharge insulin resistance is assessed by indirect methods. Insulin resistance was measured with simple indices: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Results: Research was concluded on 221 patients, 114 were in hyperglycemia group while 107 were part of normoglycemia group. There were no signifficant differences in age nor sex among groups. BMI, WHR and positive family history of DM type II showed higher values in hyperglycemia group. Patients in hyperglycemia group had signifficant higher values of insulin resistance measured with all simple insulin resistance indices compared with patients in normoglycemia group. Multivariate logistic regression analysis showed independent association of BMI, WHR, HOMA-IR and QUICKI with occurrence of hyperglycemia in acute illness. Conslusion: Occurrence of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder is associated with intrinsically increased insulin resistance

Intrinsic insulin resistance among nondiabetics and occurrence of hyperglycemia in critical illness

Uvod: Inzulinska rezistencija karakterizirana je smanjenim odgovorom ciljanih stanica na izloženu koncentraciju inzulina. Teško ju je odvojiti od šećerne bolesti tip II, metaboličkog sindroma i pretilosti, a nalazi se u podlozi nastanka kardiovaskularnih i neurodegenerativnih bolesti. Hiperglikemija u akutnoj bolesti čest je nalaz kod pacijenata hospitaliziranih u jedinicama intenzivnog liječenja. Javlja se kod pacijenata s prethodno poznatim poremećajem metabolizma glukoze (DM, IFG, IGT), kao prva manifestacija dotada nedijagnosticirane šećerne bolesti te kod pacijenta koji imaju uredan metabolizam glukoze prije i nakon hospitalizacije. Hipoteza istraživanja jest da je pojava hiperglikemije u teškoj akutnoj bolesti povezana s intrinzično povišenom inzulinskom rezistencijom kod pacijenata koji nemaju manifestan poremećaj metabolizma glukoze. Ispitanici i metode: U istraživanje su uključeni pacijenti primljeni u Zavod za intenzivnu medicinu Klinike za unutrašnje bolesti KBC Zagreb radi teške akutne bolesti. Pacijenti bez poznatog poremećaja metabolizma glukoze podijeljeni su u skupinu hiperglikemije (GUK >7.7 mmol/l u najmanje 2 mjerenja) i normoglikemije. Postojanje ranije neprepoznatog poremećaja metabolizma glukoze isključeno je određivanjem HbA1c za vrijeme hospitalizacije i OGTT učinjenim na ambulantoj kontroli 6-8 tjedana nakon hospitalizacije. Na ambulantnoj kontroli 6-8 tjedana nakon hospitalizacije pacijentima je uzet uzorak krvi natašte iz kojeg je indirektnim metodama određena inzulinska rezistencija. Inzulinska rezistencija određena je jednostavnim indeksima: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Rezultati: Istraživanje je završeno na 221 pacijentu. Hiperglikemičnu skupinu činilo je 114 pacijenata, dok se u normoglikemičnoj skupini nalazilo 107 pacijenata. Analizom podataka među skupinama nije zamjećena statistički značajna razlika u dobi niti spolu pacijenata. Vrijednost indeksa tjelesne mase, omjera struka i bokova te pozitivna obiteljska anamneza šećerne bolesti bila je statistički značajno viša u hiperglikemičnoj skupini. Skupina bolesnika koja je razvila hiperglikemiju za vrijeme akutne bolesti ima statistički značajno višu vrijednost inzulinske rezistencije nakon hospitalizacije prema svim jednostavnim indeksima u usporedbi sa skupinom koja je ostala normoglikemična za vrijeme akutne bolesti. Multivarijatna analiza logističkom regresijom pokazala je neovisnu povezanost indeksa 76 tjelesne mase, vrijednost omjera struka i bokova, HOMA-IR i QUICKI s pojavom hiperglikemije u akutnoj bolesti. Zaključak: Pojava hiperglikemije u teškoj akutnoj bolesti povezana je s intrinzično povišenom inzulinskom rezistencijom kod pacijenata koji nemaju manifestan poremećaj metabolizma glukoze.Introduction: Insulin resistance is characterized by reduced response of target cells to exposed insulin concentration. It is part of type 2 diabetes, metabolic syndrome, obesity and underlying cause of cardiovascular and neurodegenerative diseases. Hyperglycemia commonly occures in the course of any critical illness. It appeares both among patient with or without apparent glucose metabolism disorder. We hypothesised that the cause of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder lies in intrinsically increased insulin resistance of those patients. Patients and methods: Patients admitted to the intensive care unit of the University Hospital Centre Zagreb due to critical illness were included in the research. Patients with no history of impaired glucose metabolism were divided into hyperglycemia group (glucose >7.7 mmol/l, measured on at least two occasions) and normoglycemia group. Glycated haemoglobin during hospital stay and oral glucose tolerance test within 6-8 weeks after discharge were all performed in order to disclose patients with unknown diabetes or pre-diabetes who were excluded from the research. On the ambulatory appointment 6-8 weeks after discharge insulin resistance is assessed by indirect methods. Insulin resistance was measured with simple indices: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Results: Research was concluded on 221 patients, 114 were in hyperglycemia group while 107 were part of normoglycemia group. There were no signifficant differences in age nor sex among groups. BMI, WHR and positive family history of DM type II showed higher values in hyperglycemia group. Patients in hyperglycemia group had signifficant higher values of insulin resistance measured with all simple insulin resistance indices compared with patients in normoglycemia group. Multivariate logistic regression analysis showed independent association of BMI, WHR, HOMA-IR and QUICKI with occurrence of hyperglycemia in acute illness. Conslusion: Occurrence of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder is associated with intrinsically increased insulin resistance

Intrinsic insulin resistance among nondiabetics and occurrence of hyperglycemia in critical illness

Uvod: Inzulinska rezistencija karakterizirana je smanjenim odgovorom ciljanih stanica na izloženu koncentraciju inzulina. Teško ju je odvojiti od šećerne bolesti tip II, metaboličkog sindroma i pretilosti, a nalazi se u podlozi nastanka kardiovaskularnih i neurodegenerativnih bolesti. Hiperglikemija u akutnoj bolesti čest je nalaz kod pacijenata hospitaliziranih u jedinicama intenzivnog liječenja. Javlja se kod pacijenata s prethodno poznatim poremećajem metabolizma glukoze (DM, IFG, IGT), kao prva manifestacija dotada nedijagnosticirane šećerne bolesti te kod pacijenta koji imaju uredan metabolizam glukoze prije i nakon hospitalizacije. Hipoteza istraživanja jest da je pojava hiperglikemije u teškoj akutnoj bolesti povezana s intrinzično povišenom inzulinskom rezistencijom kod pacijenata koji nemaju manifestan poremećaj metabolizma glukoze. Ispitanici i metode: U istraživanje su uključeni pacijenti primljeni u Zavod za intenzivnu medicinu Klinike za unutrašnje bolesti KBC Zagreb radi teške akutne bolesti. Pacijenti bez poznatog poremećaja metabolizma glukoze podijeljeni su u skupinu hiperglikemije (GUK >7.7 mmol/l u najmanje 2 mjerenja) i normoglikemije. Postojanje ranije neprepoznatog poremećaja metabolizma glukoze isključeno je određivanjem HbA1c za vrijeme hospitalizacije i OGTT učinjenim na ambulantoj kontroli 6-8 tjedana nakon hospitalizacije. Na ambulantnoj kontroli 6-8 tjedana nakon hospitalizacije pacijentima je uzet uzorak krvi natašte iz kojeg je indirektnim metodama određena inzulinska rezistencija. Inzulinska rezistencija određena je jednostavnim indeksima: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Rezultati: Istraživanje je završeno na 221 pacijentu. Hiperglikemičnu skupinu činilo je 114 pacijenata, dok se u normoglikemičnoj skupini nalazilo 107 pacijenata. Analizom podataka među skupinama nije zamjećena statistički značajna razlika u dobi niti spolu pacijenata. Vrijednost indeksa tjelesne mase, omjera struka i bokova te pozitivna obiteljska anamneza šećerne bolesti bila je statistički značajno viša u hiperglikemičnoj skupini. Skupina bolesnika koja je razvila hiperglikemiju za vrijeme akutne bolesti ima statistički značajno višu vrijednost inzulinske rezistencije nakon hospitalizacije prema svim jednostavnim indeksima u usporedbi sa skupinom koja je ostala normoglikemična za vrijeme akutne bolesti. Multivarijatna analiza logističkom regresijom pokazala je neovisnu povezanost indeksa 76 tjelesne mase, vrijednost omjera struka i bokova, HOMA-IR i QUICKI s pojavom hiperglikemije u akutnoj bolesti. Zaključak: Pojava hiperglikemije u teškoj akutnoj bolesti povezana je s intrinzično povišenom inzulinskom rezistencijom kod pacijenata koji nemaju manifestan poremećaj metabolizma glukoze.Introduction: Insulin resistance is characterized by reduced response of target cells to exposed insulin concentration. It is part of type 2 diabetes, metabolic syndrome, obesity and underlying cause of cardiovascular and neurodegenerative diseases. Hyperglycemia commonly occures in the course of any critical illness. It appeares both among patient with or without apparent glucose metabolism disorder. We hypothesised that the cause of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder lies in intrinsically increased insulin resistance of those patients. Patients and methods: Patients admitted to the intensive care unit of the University Hospital Centre Zagreb due to critical illness were included in the research. Patients with no history of impaired glucose metabolism were divided into hyperglycemia group (glucose >7.7 mmol/l, measured on at least two occasions) and normoglycemia group. Glycated haemoglobin during hospital stay and oral glucose tolerance test within 6-8 weeks after discharge were all performed in order to disclose patients with unknown diabetes or pre-diabetes who were excluded from the research. On the ambulatory appointment 6-8 weeks after discharge insulin resistance is assessed by indirect methods. Insulin resistance was measured with simple indices: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Results: Research was concluded on 221 patients, 114 were in hyperglycemia group while 107 were part of normoglycemia group. There were no signifficant differences in age nor sex among groups. BMI, WHR and positive family history of DM type II showed higher values in hyperglycemia group. Patients in hyperglycemia group had signifficant higher values of insulin resistance measured with all simple insulin resistance indices compared with patients in normoglycemia group. Multivariate logistic regression analysis showed independent association of BMI, WHR, HOMA-IR and QUICKI with occurrence of hyperglycemia in acute illness. Conslusion: Occurrence of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder is associated with intrinsically increased insulin resistance

Hyperglycaemia in critical illness is a risk factor for later development of type II diabetes mellitus

Hyperglycaemia caused by stress and inflammation is common during critical illness. We hypothesised that a latent glucose metabolism disturbance contributes to development of hyperglycaemia and that those patients have increased risk for diabetes. We included patients with sepsis, acute coronary syndrome and acute heart failure with no history of impaired glucose metabolism and divided them in the hyperglycaemia group (glucose ≥ 7.8 mmol/l) and normoglycaemia group. Patients were followed for 5 years. Follow-up was completed for 115 patients in the normoglycaemia group, of which 4 (3.5%) developed type 2 diabetes. In the hyperglycaemia group 51 patients finished follow-up and 8 (15.7%) developed type 2 diabetes. Relative risk in 5-year period for patients with hyperglycaemia was 4.51 for development of type 2 diabetes. Patients with hyperglycaemia during critical illness who are not diagnosed with diabetes before or during the hospitalisation should be considered a population at increased risk for developing diabetes

Increased plasma N-glycome complexity is associated with higher risk of type 2 diabetes

Better understanding of type 2 diabetes and its prevention is a pressing need. Changes in human plasma N-glycome are associated with many diseases and represent promising diagnostic and prognostic biomarkers. Variations in glucose metabolism directly affect glycosylation through the hexosamine pathway but studies of plasma glycome in type 2 diabetes are scarce. The aim of this study was to determine whether plasma protein N-glycome is changed in individuals who are at greater risk of developing type 2 diabetes